Published online Aug 7, 2019. doi: 10.3748/wjg.v25.i29.3996
Peer-review started: May 6, 2019
First decision: June 10, 2019
Revised: June 28, 2019
Accepted: July 5, 2019
Article in press: July 5, 2019
Published online: August 7, 2019
The necessity of additional gastrectomy for early gastric cancer (EGC) patients who do not meet curative criteria after endoscopic submucosal dissection (ESD) is controversial.
To examine the clinicopathologic characteristics of patients who underwent additional laparoscopic gastrectomy after ESD and to determine the appropriate strategy for treating those after noncurative ESD.
We retrospectively studied 45 patients with EGC who underwent additional laparoscopic gastrectomy after noncurative ESD from January 2013 to January 2019 at the Cancer Hospital of the Chinese Academy of Medical Sciences. We analyzed the patients’ clinicopathological data and identified the predictors of residual cancer (RC) and lymph node metastasis (LNM).
Surgical specimens showed RC in ten (22.2%) patients and LNM in five (11.1%). Multivariate analysis revealed that positive horizontal margin [odds ratio (OR) = 13.393, 95% confidence interval (CI): 1.435-125, P = 0.023] and neural invasion (OR = 14.714, 95%CI: 1.087-199, P = 0.043) were independent risk factors for RC. Undifferentiated type was an independent risk factor for LNM (OR = 12.000, 95%CI: 1.197-120, P = 0.035). Tumors in all patients with LNM showed submucosal invasion more than 500 µm. Postoperative complications after additional laparoscopic gastrectomy occurred in five (11.1%) patients, and no deaths occurred among patients with complications.
Gastrectomy is necessary not only for patients who have a positive margin after ESD, but also for cases with neural invasion, undifferentiated type, and submucosal invasion more than 500 µm. Laparoscopic gastrectomy is a safe, minimally invasive, and feasible procedure for additional surgery after noncurative ESD. However, further studies are needed to apply these results to clinical practice.
Core tip: It is controversial whether additional gastrectomy is necessary for all patients who do not meet the curative criteria after endoscopic submucosal dissection (ESD). Therefore, it would be valuable to determine which factors could increase the risk of residual cancer or lymph node metastasis in patients after noncurative ESD in order to avoid unnecessary surgery. We found that gastrectomy was necessary not only for patients who had a positive margin in ESD, but also for cases with neural invasion, undifferentiated type, and submucosal invasion more than 500 µm. Laparoscopic gastrectomy is a safe, minimally invasive, and feasible procedure for additional surgery after noncurative ESD.